SPIRILLACE.E AND THE DISEASES CAUSED BY THEM 349 



Egypt, Russia, Turkey and Italy. The fifth and sixth invasions 

 have been very much restricted, largely without doubt because 

 of the modern methods founded upon knowledge of its causation. 

 Cholera was epidemic in the United States in 1833-35, 1848-54, 

 1871-73, and there were a few cases in 1893 and again in 1910. 

 The disease occurs as a protracted epidemic in which the infection 

 passes from person to person, and as an explosive epidemic in 

 which many people are stricken at once as a result of con- 

 tamination of the public water-supply. 



The causal relationship of Spirillum cholera to human Asiatic 

 cholera is no longer questioned. Several laboratory workers 

 among them R. Pfeiffer and E. Oergel, have suffered typical 

 attacks of the disease as a result of accidental laboratory inocula- 

 tion. Dr. Oergel received some peritoneal fluid from an inocu- 

 lated guinea-pig into his mouth and he died of cholera. Petten- 

 koffer and Emmerich, in order to disprove the supposed causal 

 relation of this organism to cholera, took some alkaline water 

 and then water containing a minute quantity of a fresh culture. 

 The former investigator had a severe diarrhea and the latter a 

 severe and dangerous attack of typical cholera from which he 

 eventually recovered. The organism was recovered from the 

 stools in all these instances. 



The cholera spirilla enter the body with the food and drink 

 and if they escape the germicidal action of the gastric juice they 

 may establish themselves in the intestine. In an acute case of 

 cholera they multiply here enormously and induce a severe 

 enteritis in which large quantities of fluid are secreted into the 

 lumen of the intestine and discharged from the rectum along with 

 bits of desquamated epithelium and enormous numbers of cholera 

 spirilla. The germs do not pass through the intestinal wall, but 

 they multiply on and in the intestinal epithelium as well as in 

 the intestinal contents. The general symptoms, shock, coma 

 and the ultimate death, seem to be due in part to the absorption 

 of poisons from the intestine and in part to the severe local irrita- 

 tion in the abdomen. 



